FL H0459

Health insurers and health maintenance organizations cannot require step-therapy protocols for prescription drugs if the insured/subscriber was previously approved for the same drug by another health coverage plan and that plan paid for it within the 90 days before the request, with documentation provided.

Health insurers and HMOs must publish procedures on their websites and provide to insureds/subscribers the process for requesting protocol exemptions or appealing denials, including request methods, timeframes for decisions (within reasonable time), and appeal procedures.

Protocol exemption authorizations must specify the approved drug or treatment, while denials must include a written explanation of the reason, clinical rationale supporting the denial, and appeal procedures.

Health insurers and HMOs may request relevant medical records to support protocol exemption requests.

The bill takes effect July 1, 2022, and does not require insurers or HMOs to add drugs to formularies or cover drugs they do not otherwise cover.